中老年人群中肝酶学指标与糖耐量受损发病率关系的队列随访研究  

A cohort follow-up study of the relationship between serum liver enzymes and the incidence of impaired glucose tolerance in middle-aged and elderly Chinese people

作　　者：张淼 张巧 肖芳芳 彭年春 胡颖 时立新 

机构地区：[1]贵州医科大学附属医院内分泌代谢科,贵阳550004

出　　处：《中华内分泌代谢杂志》2018年第1期16-23,共8页Chinese Journal of Endocrinology and Metabolism

基　　金：贵州省科技合作计划[黔科合LH字(2015)7413号];国家重点研发计划资助(2016YFC0901200);2016年贵州省临床重点专科培育项目(SZD-2016-01)

摘　　要：目的研究血清肝酶学指标[丙氨酸氨基转移酶（ALT）、γ-谷氨酰转移酶（GGT）、天门冬氨酸氨基转移酶（AST）]与糖耐量受损（IGT）发病率的相关性。 方法选取2011年参加REACTION研究的贵阳市社区中老年居民，其中经口服葡萄糖耐量试验（OGTT）明确血糖正常及血清ALT在参考范围的4 228人作为基线人群，基线调查包括问卷调查、体格检查（身高、体重、血压、腰围等），以及血清ALT、AST、GGT及总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹及OGTT 2h血糖、空腹胰岛素（FINS）的检测。3年后随访，根据基线肝酶水平进行四分位分组，分别计算3年后各组IGT发病率。采用单因素方差分析比较发生IGT组和血糖正常组基线各项指标。采用多元回归方程分析肝酶学指标四分位分组后各组患IGT的风险。采用logistic回归模型评估各组发生IGT的相对危险度。 结果3年后随访，死亡35人，现场随访3 188人，其中血糖正常2 400人，新诊断糖尿病61人，空腹血糖受损（IFG）91人，IGT 636人。IGT的发病率随着基线ALT水平的增加而显著增加（P〈0.01），Logistic回归分析显示，调整相关危险因素（包括年龄、体重指数、经常吸烟、经常饮酒、规律运动、糖尿病家族史、HOMA-IR、基线餐后2h血糖、GGT）后，基线ALT水平最高组IGT发病风险为最低组的1.462倍（95%CI 1.129~1.891）。性别分组分析显示，仅女性组IGT发病率与基线ALT水平相关，基线ALT水平最高组发生IGT的风险为最低组的1.481倍（95%CI 1.107~1.981）。而基线GGT及AST水平与IGT发病率无相关性。 结论在中老年女性中，即使是参考范围内ALT水平的升高也可能是IGT发病的危险因素。ObjectiveTo study the relationship between liver enzymes [alanine transaminase（ALT）, gamma-glutamyltransferase（GGT）, aspartate amino transferase（AST）] and the incidence of impaired glucose tolerance（IGT）in middle-aged and elderly people. MethodsA group of middle-aged and elderly residents who participated in the REACTION study in 2011 from Guiyang community were enrolled in our study. Of which, a total of 4 228 participants with normal blood glucose detected by oral glucose tolerance test（OGTT）and serum ALT levels were investigated as baseline population. The baseline survey included questionnaire survey and physical examination（height, weight, waist circumference, blood pressure, etc.）, and the serum ALT, AST, GGT, total cholesterol（TC）, triglyceride（TG）, high density lipoprotein-cholesterol（HDL-C）, low density lipoprotein-cholesterol（LDL-C）, fasting blood glucose, postprandial 2h plasma glucose（2hPG）in OGTT, and fasting insulin（FINS）were tested. After 3 years of follow-up, all subjects received quartile grouping according to the basal liver enzyme levels, and the incidence of IGT was respectively calculated. One-way analysis of variance was used to compare the differences of basal liver enzyme levels between IGT and normal blood glucose groups. The risk of IGT based on quartile grouping was assessed by multivariate regression analysis, and the odds ratios（ORs）were estimated by the logistic regression model. ResultsAfter eliminating the 35 died patients, 3 188 participants were followed over 3 years. Among them, 2 400 subjects revealed normal blood glucose level, 61 developed into type 2 diabetes mellitus（T2DM）, 91 developed into IFG, and 636 developed into IGT. The incidence of IGT increased along with the elevation of serum ALT level（P〈0.01）. After adjusting the risk factors including body mass index, regular smoking, regular drinking, regular exercise, family history of diabetes, homeostasis model assessment for insulin resistant index（HOMA

关 键 词：丙氨酸氨基转移酶 Γ-谷氨酰转移酶 天门冬氨酸氨基转移酶 糖耐量受损 队列研究 

分 类 号：R587.1[医药卫生—内分泌]